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10/22/2013

The most common causes of burn injuries in Nepal include open cooking fires where women catch their scarves on fire, flame burns from hot oils and children who play too close to a pot of water while mom is cooking or just being too curious. Burns can also occur when people sleep too close to fires to stay warm and may accidently pitch or roll onto fires.

One of the most severe burns I have helped treat on this trip is of a 4-month-old infant girl named Astha. She was in a traditional ritual at two months of age for newborns where they are anointed with oil. She was lying on her mother’s lap and keeping warm close to an open fire. Her mother leaned forward and Astha accidently fell into the fire, sustaining severe burns to her face and right hand.

Due to the limited understanding of treatment of acute burns early, she developed the tightness of scars over her face to where her mouth almost completely closed to almost less than a 0.5cm diameter opening. She was limited to getting her nutrition through a small eyedropper and unable to suck.

Astha was brought to the burn hospital just before we arrived. The therapist, Mohan, remembered a plastic splint that I had shown him years ago and made one that hooked onto the corners of Astha’s mouth and stretched it apart with a rubber band extended behind her head.

It may look like something from “Silence of the Lambs,” but it worked! Within one day of wearing it, the mouth opening expanded to just larger than 0.5cm. With some suggestions for modification to Mohan, we changed the splint each day and Astha’s mouth opening is almost 1.5 cm.

Her mother is ecstatic to be able to feed her more easily with the eyedropper, and Astha is even sucking now. With her mother’s persistence and dedication, I know Astha will survive and thrive.

10/08/2013

Thanks to Joe Lippi, Associate Director of Medical Education and Outreach, for sending these excellent photos from the visiting educator trip in Nepal:

Nancy Chee (ReSurge volunteer occupational therapist) and Mohan Dangol (local occupational therapist and longtime friend and partner of ReSurge) assess the progress on a 4-month old child with serious burns across her entire face and arm.

10/03/2013

This is my first trip as an employee of ReSurge. Though I have been fortunate enough to travel
to some developing countries for school or previous work, there is something
profoundly different about this trip.

First, the team and their level of dedication to this work and to these
patients is truly an inspiration. This
is hard work. The days are long and exhausting, and every volunteer is using
two weeks of precious vacation time to work as hard or harder than they do
during their usual jobs. It takes a
special breed of human being to do that, and clearly these ReSurge volunteers
are of that breed.

I’ve also had the
opportunity to observe the treatment experience of several patients from end to
end. I’ve been able to spend time with patients
with burn scar contractures as they awaited their surgery; I’ve observed the
fascinating surgeries take place; I’ve watched the recovery process and the
dressings, splinting and occupational therapy of patients post-operatively. Burn surgeries are truly a life-changing intervention,
and I’ve been lucky enough to see that first hand.

To treat the wounds and design a device to open up the
nearly burned shut mouth of a four month old child with burns throughout her
face and body is to give her a chance to eat, to breathe, to survive.

To operate on a young boy’s arm to return the
extension of his fingers and arm is to allow him to not only play with his
friends but to hold a pencil. To raise his hand fully in class.

To release the burn scar contractures on both arms of a
grandfather and give him the proper splint and exercises to ensure that
function is truly restored is to enable him to care for his grandchild and to
return to work—to keep his family together.

The patients here are an inspiration. They are strong, brave, and resilient. The ReSurge volunteers who have traveled
across the world to offer up their experiences, ideas and wisdom are helping
the talented staff of Kirtipur Hospital expand its knowledge and improve
patient care. This hospital is a special
place with endless potential to be a world-class center for reconstructive
surgery.

The work being done by Dr.
Shankar Rai and his staff of physicians, nurses and support personnel is a model
for how the highest quality, dignified care can be provided to some of the
poorest people on earth. It’s been an
amazing trip so far, and I’m honored to be part of an organization that works
with such dedicated humanitarians to deliver care to those who need it
most.

10/02/2013

I met a beautiful 11-year-old girl in Kirtipur, Nepal. Her home land is in a village high on a hill.

One day over 6 months ago, she got a burn accident from a slip on a pan of boiling oil when she went to the market. I could not imagine how hard and how painful it has been since that time, but it's not finished yet because her knee has been bent so she cannot walk.

She came to the hospital this morning for surgery to release the scar at her knee. I think that she has been waiting for this surgery for a long time because I saw in her eyes the willingness to walk normally after surgery.

She was offered the option of spinal anesthesia if she would be ok to be awake during surgery. I thought that she must be sedated. But after a little bit of tears because of the needle of spinal she smiled and cooperated very well. She speaks a little bit of English so she asked me my name and she said she was ok every time I asked her how did she feel.

I took a picture of me and her and she wanted me to take the pictures of her surgery that was happening behind the barrier of the surgical area. I did one.

She asked more and she was very brave to overcome her fear of this surgery. She was very happy to see the pictures of her knee straight.

The surgery was done and I was so happy to have the picture of her before leaving the OR with her thumb raised up. I told her, "you are number one."

10/01/2013

The team has now been in Kathmandu for over one
week. It’s funny how quickly a place can
feel like home.

After spending a weekend
in the beautiful town of Pokhara, we all
found ourselves asking things like “what time is our flight home [to
Kathmandu]?”

Kathmandu is a dusty maze of semi-paved, pothole-filled
narrow streets that meander around beautiful pagodas and temples,
up hills and over rivers. The air is thick—both with a warm, damp
humidity and the smell of burning incense, simmering curry,
and steaming "mo-mos" (Nepali dumplings).

Looking out at the horizon you see
Kathmandu’s low colorful skyline near and beautiful mountain ranges in the
distance that are hidden and revealed over and over as the clouds drift in and
out of view. It’s a magnificent place.

The members of this team—Nancy Chee, Bonnie MacEvoy, Anne
Dinsmore, Vickie Van Fechtmann, Sandy Dore-Harris and Len Sterling—are
pros. Not simply because they all have a history of volunteering with ReSurge and are talented in their
own professions, but rather because every morning they are up early and are
anxious to get to work.

Every evening they debrief the day—discussing what
worked and what didn’t and how to make the next one better. And every day they
work relentlessly hard to deliver informative, relevant, and thoughtful
lectures and workshops to a room full of nurses and physicians. It’s hard work to educate for hours on end in
this context, and it’s even harder when those lectures and workshops are
redesigned almost every night to respond to the observed needs of the students
and the hospital. But this team does it,
and they do it remarkably well.

The majority of the participants in the lectures and
workshops are new nurses who graduated and passed their qualifying examinations
only very recently. They are 15 sharp,
eager young women. The ReSurge team has been working closely with them to
augment their skill sets, present materials and topics in novel ways, and to expose them to nursing techniques in the care of patients with
burn injuries, in particular—the thematic focus of this trip.

Nurse educator Len Sterling delivers a lecture on burn care to a room of new nurses at Kirtipur Hospital.

Days when our Nepali colleagues are doing operations, our
volunteer nurses and anesthesiologist observe the work, take notes on what
systems or practices might be improved, and engage in real time dialogue with
the medical team. Nancy, the trip’s
occupational therapist, is working side by side with Mohan Dangol, her longtime
Nepali counterpart whom she helped train (this is her fifth time working with
him).

The two of them do amazing things
with simple materials—creating life-changing (and perhaps life-saving) braces,
splints and other tools to dramatically improve the healing and restoration of
function for the patients with burn injuries.
It’s an amazing thing to observe.

09/27/2013

Last week, ReSurge began its 44th trip season by sending out a team of visiting educators to Kathmandu, Nepal. The team of seven includes two post-anesthesia care unit (PACU) nurses, an ICU burn specialist nurse, a hand therapist, a circulating RN, a team coordinator, and Bonnie MacEvoy, an anesthesiologist.

Bonnie has been keeping a blog with excellent updates on the work the team has been doing (note: some images posted on the blog are of surgical procedures). Here are some excerpts from her blog on her time in Nepal:

We have 15 nursing students, 2 anesthesia assistants, 2 surgical residents, 2 plastic surgery residents, the staff nurses, and a visiting medical student from Germany whose English puts me to shame. It is a wide audience and targeting our teaching - also given that English is a distant second language for most of them – is going to be tricky.

I am amazed at how quickly the nurses have come up with a plan of action and a list of lectures to do for our class of 15 nurses. And they are amazing teachers.

We had a scenario of a burn victim brought into the hospital from a fall and burn. Sandy, one of our PACU nurses, we covered with smears of charcoal and vaseline with plastic to make fake blisters. She had charcoal on her nose to inspire a discussion on inhalational injuries, a circumferential "burn" on her lower leg to talk about compartment syndrome, and a large burn on her back that might be missed if no one examined her thoroughly. Len [the burn nurse educator] did a fantastic job and so many various teaching points came up as the new nurses were guided through the care of this "patient."

Volunteer educators give lesson on burn injuries

I did a lecture about pharmacology with questions that when answered correctly were rewarded with a peanut M&M. By the end they all chimed in at once and everyone got a treat.

Sandy, Vickie, and Anne did a scenario with monitors and the hooking-up of patients as they arrive in the PACU. I got to be one of the patients and lay still as these gentle and tentative little hands moved about trying to understand and do each task. Every now and then something would make me smile and they would all laugh.

Now and then I would get a little pat or someone would be holding my hand. I kept my eyes closed to be a good post-operative dummy, but when I opened and saw the seven or so faces around me, they would all smile. Such amazing young women with so much interest and promise.

We are very grateful to Bonnie for sharing her blog and photos with us, and we are grateful to each of our volunteers for the excellent work they are doing. Stay tuned for more updates from Nepal!